수술과 항혈소판제

수술과 항혈소판제

이전에 NEJM 에 실린 시술이나 수술 전에 항응고제를 중단하는 방법을 리뷰한 저널에 대해 기록해 놓은 것이 있었는데, 오늘 만난 환자분은 disgren (Triflusal) 을 복용하고 있는 분이었습니다. 이 분은 간생검을 해야하는데, 출혈이 우려되었습니다. 그래서 이 약을 언제 중단을 해야할지 이전에 적어놓은 그 기록에도 나오지 않아 인터넷에서 자료를 검색하던 중 괜찮은 자료가 있어 기록으로 남겨놓습니다.

항혈소판제의 분류

Antiplatelet group 1

the risk of bleeding linked to the effects of antiplatelet drugs is dose dependent and irreversible, that is, it lasts for the life of the platelet (10 days). Discontinuing medication 5 days before surgery ensures a platelet regeneration of 50%, sufficient for cor‐rect hemostasis if the platelet count was normal prior to discontinuing the medication.

Antiplatelet group II (thienopyridines)

More potent than acetylsalicylic acid, but also with an irreversible effect for the 10‐day lifetime of the platelet. These carry a higher risk of bleeding than group I drugs.

Antiplatelet group III (GPIIb/IIa receptor antagonists)

the most potent antiplatelet drugs, albeit with a shorter half‐life. The safety time before surgery is 48 h for Abciximab and 8 h for Tirofiban and Eptifibatide.

...

Surgery and antiplatelet drugs after cardiovascular events

• Antiplatelet drugs are used in the prophylaxike and ischemic heart disease.

• Because their use leads to changes in hemostasis (perioperative bleeding), they should be discontinued several days before surgery.

• Approximately 5% of acute coronary syndromes and ischemic strokes are preceded by a complete withdrawal of daily preventative antiplatelet drugs. This percentage increases to 10% in at‐risk patients.

Emergency surgery in patients on antiplatelet drugs

• Prophylactic transfusion of platelets is not indicated, although there should be some in reserve.

• Anemia, hemodilution, and hypothermia must be avoided.

• Desmopressin is administered (MINURIN®) at a dose of 0.3 μg/kg iv instilled over 30 minutes.

• Factor VII (its use is controversial).

When to reintroduce antiplatelet drugs

• Early reintroduction after surgery: several studies suggest reintroducing antiplatelet drugs 24 h after open/laparoscopic surgery.

Antiplatelet effect of NSAIDs/analgesics

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2018. 10. 16 - SJH